PD36-09 A NOVEL COLLABORATION FOR SUCCESSFUL MANAGEMENT OF GENITO-PELVIC DYSESTHESIAS MEDIATED BY RADICULOPATHY OF SACRAL SPINAL NERVE ROOTS WITHIN THE CAUDA EQUINA: FOUR-YEAR EXPERIENCE

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Female (PD36)1 Apr 2020PD36-09 A NOVEL COLLABORATION FOR SUCCESSFUL MANAGEMENT OF GENITO-PELVIC DYSESTHESIAS MEDIATED BY RADICULOPATHY OF SACRAL SPINAL NERVE ROOTS WITHIN THE CAUDA EQUINA: FOUR-YEAR EXPERIENCE Choll Kim, Jennifer Blevins, Barry Komisaruk, Jessica Yih*, Sue Goldstein, and Irwin Goldstein Choll KimCholl Kim More articles by this author , Jennifer BlevinsJennifer Blevins More articles by this author , Barry KomisarukBarry Komisaruk More articles by this author , Jessica Yih*Jessica Yih* More articles by this author , Sue GoldsteinSue Goldstein More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000907.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2012, Komisaruk et al introduced the concept that neurologic-based women’s sexual health issues, genito-pelvic dysesthesias, could be caused by radiculopathy of sacral spinal nerve roots within the cauda equina. Over the last 4 years, to more effectively manage patients with suspected cauda equina pathology, a robust collaboration among sexual medicine, spine surgery and neurophysiology disciplines has been established. The aim of this study is to review the collaborative experience in managing patients with genito-pelvic dysesthesia (GPD). METHODS: We defined GPD in the broadest sense to include both unwanted, unrelenting, distressing arousal, pain and/or itching symptoms >6 mo (hyperfunction), and also persistent degrees of genital anesthesia leading to orgasmic dysfunction >6 mo (hypofunction). Charts were reviewed retrospectively from 2015 - 2019 of GPD patients presenting to our sexual medicine facility where neurogenital testing results were consistent with radiculopathy of sacral spinal nerve roots within the cauda equina. Lumbar and sacral MRIs were obtained and reviewed in collaborative bi-monthly meetings in the spine surgeon’s facility and identified as having or not having treatable spinal abnormalities, subdivided into subtle or obvious. When appropriate, a transforaminal epidural spinal injection (TFESI) or caudal block with anesthetic agent and/or steroid was administered and the outcome measured by Patient Global Impression of Improvement (PGI-I). Those with clinically significant symptom reduction were considered for minimally invasive spine surgery (MISS). RESULTS: 734 patients (586 women; 80%; mean age 47 +/- 24) met criteria for this retrospective chart review. 637 lumbar and/or sacral MRIs were reviewed. A total of 112 TFESI were performed, 90 of which showed positive responses with more than 60% improvement on PGI-I of 1,2. 57 surgeries were performed. 17 patients (71% women) with PGAD underwent MISS for herniated nucleus pulposus and or annular tear. 76% declared post-op clinical improvement with PGI-I 1,2,3 with mean follow-up of 12 months (4 - 30 months). CONCLUSIONS: Cauda equina pathology can cause unwanted, unrelenting, distressing neurologic-based GPD from radiculopathy of sacral spinal nerve roots. In selected cases these GPDs may be reversed by MISS. There are management benefits from collaboration among sexual medicine, spine surgery and neurophysiology subspecialists. Source of Funding: Not funded. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e726-e726 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Choll Kim More articles by this author Jennifer Blevins More articles by this author Barry Komisaruk More articles by this author Jessica Yih* More articles by this author Sue Goldstein More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement PDF downloadLoading ...